National Medicaid Fraud in Child Welfare Summit

This has been on my agenda for years.

It has been on the Presidential agenda for years.

Now, it is on the national agenda.

FOR IMMEDIATE RELEASE Thursday, January 28, 2010

Contact: HHS Press Office: (202) 690-6343 DOJ Press Office: (202) 514-2007

Health & Human Services Secretary Kathleen Sebelius, Attorney General Eric Holder Convene National Summit on Health Care Fraud, Unveil Historic Commitment to Fighting Fraud in President’s FY 2011 Budget

Summit Brings Private and Public Sectors, Law Enforcement Together to Fight Fraud 

U.S. Department of Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder today joined private sector leaders, law enforcement personnel and health care experts for a landmark National Summit on Health Care Fraud. The summit is the first national gathering on health care fraud between law enforcement and the private and public sectors and is part of the Obama Administration’s coordinated effort to fight health care fraud.

“The Obama Administration has zero tolerance for health care fraud and abuse,” said Secretary Sebelius. “Building on the work we have accomplished through HEAT (the Health Care Fraud Prevention & Enforcement Action Team), I am pleased to announce here at the National Summit on Health Care Fraud that the President’s FY 2011 Budget being unveiled next week will include historic support for anti-fraud efforts that will save billions over 10 years. He will call for increased investments in programs that have a proven record of preventing fraud, reducing payment errors and returning funds to the Trust Funds.”

“Health care fraud affects all Americans and demands a coordinated, national response,” said Attorney General Holder. “HEAT has proven that better collaboration is the key to combating these crimes, recovering stolen resources, and protecting essential Medicare and Medicaid dollars.  We welcome the private sector’s participation in this work – together, I’m confident we can make great strides in identifying, preventing, and punishing health care fraud.”

The National Summit features discussions of innovative ways to eliminate fraud and abuse in the U.S. health care system. The morning program includes remarks from Secretary Sebelius, Attorney General Holder, Congressman Ron Klein and James Roosevelt Jr. CEO of Tufts Health Care, who will address the important role of the private sector in fighting fraud. Later, officials from the Departments of Health and Human Services and Justice will participate in a panel discussion about methods being used to prevent and crack down on health care fraud.
In the afternoon, workgroups will focus on the:

• Use of technology to prevent and detect health care fraud and improper payments.
• Role of states in preventing health care fraud.
• Development of effective prevention policies and methods for insurers, providers and beneficiaries.
• Effective law enforcement strategies.
• Measuring health care fraud, assessing recoveries and determining resource needs.

Summaries of the workgroup discussions will be compiled in a publicly available report that will help strengthen the federal government and private sector’s work to deter health care fraud.

“Health care fraud isn’t just a government problem. Criminals don’t discriminate and they are stealing from Medicare, Medicaid and private companies at an unacceptable rate,” said Sebelius. “We have a shared interest in stopping these crimes and today’s summit brought us together to discuss how we can all work together to fight fraud.”

The National Summit is the latest initiative of HEAT, which was announced by Attorney General Holder and Secretary Sebelius in May 2009. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid fraud through enhanced cooperation. Expansion of the Medicare Fraud Strike Force operations is a key component of the HEAT taskforce. Strike Force Teams initially began in Miami in 2007 and expanded to Los Angeles in 2008.  Since the formation of HEAT,  the Strike Force has expanded to Detroit; Houston; Brooklyn, N.Y.; Baton Rouge, La. and Tampa, Fla..<=Major Child Welfare Fraud States.


To date, Strike Force Teams have obtained indictments of more than 500 individuals and organizations that collectively have falsely billed the Medicare program for more than one billion dollars.
For more information on the National Summit, visit www.healthcarefraudsummit.com.

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For more information about the Summit, contact stophealthfraud@hhs.gov. View the Summit Opening Plenary Session live on January 28, 2010 from 9:30 a.m. to 12:00 p.m. ET and the Closing Plenary Remarks from 3:00 to 4 p.m. ET via Webcast at www.StopMedicareFraud.gov.


Child Welfare fraud will end, and it will be done by the people, for the children. If you suspect fraud in child welfare, report it.

Sheriff Sebelius Ain't Reconin' Medicaid Fraud In Child Welfare

U.S. cracks down on healthcare fraud

The U.S. attorney's office and Health and Human Services Department are teaming up to fight Medicare and Medicaid fraud, which costs taxpayers billions of dollars a year

By Lisa Girion and Duke Helfand, Los Angeles Times
August 27, 2010
Dr. Anne Peters knew something was wrong when a fellow physician called to find out why she had been ordering so many MRIs for her patients.

The Los Angeles internist said she tried to alert authorities that someone was illegally using her physician identification and Medicare billing numbers to submit phony claims.

For months, Peters said, she couldn't get anyone to listen. Because thieves had recruited or created phantom patients, the doctor had no way of resolving the problem. "Every agency told me the victim — i.e., the patient — had to report the fraud," Peters recalled.

On Thursday, top Obama administration officials outlined new federal enforcement efforts to combat such healthcare fraud, saying quickly expanding criminal enterprises are costing taxpayers billions of dollars each year.

During a healthcare fraud summit in Los Angeles, Atty. Gen. Eric H. Holder Jr. and Health and Human Services Secretary Kathleen Sebelius said their agencies were jointly targeting fraud in the federal Medicare and Medicaid programs. They said the initiative, launched in May 2009, had so far produced more than 580 criminal convictions and recovered more than $2.5 billion in fraudulent proceeds.

"Our healthcare system is essentially under siege by criminals intent on lining their own pockets at the expense of the American taxpayers," Holder told the gathering of law enforcement officials, regulators, healthcare executives and others at Los Angeles City College. "In Los Angeles, these crimes have reached crisis proportions, driving up healthcare costs for everyone and also bringing the long-term solvency of our essential Medicare and Medicaid programs into doubt."

Sebelius said the federal Centers for Medicare and Medicaid Services issued a final regulation Thursday to protect seniors against fraudulent medical equipment and supplies vendors.

The new rule will require suppliers of prosthetics and other items to maintain proper ordering documentation and to remain open to the public at least 30 hours a week. It also will bar such companies from using cellphones or pagers as primary business phone numbers.

"The days when you could just hang a shingle out over a desk and start submitting claims are over," Sebelius told the gathering.

Sebelius also recounted Peters' saga, fresh from a firsthand look at the scene of the alleged crime. Before the summit, Sebelius and Peters paid a visit to the Van Nuys office building that housed the purported radiology clinic that conducted the phony MRIs.

Sebelius apologized to Peters for the lackluster response to her reports of identity theft and assured her that the new healthcare reform law armed the government with new weapons to fight such fraud. Peters' complaint led to the arrest and prosecution of six people involved in what federal officials described as a well-organized medical fraud ring. Before it unraveled, the ring stole the identities of 19 physicians and used them to defraud Medicare of nearly $7 million.

"There is a new sheriff in town," Sebelius told Peters.


Hey Sheriff, can I be the deputy sheriff in charge of going after Medicaid Fraud in Child Welfare this multi-billion dollar a year racket or are you going to continue to let the State Medicaid Fraud Control Units ignore it?

HHS Health Care Fraud Prevention Summit In Detroit

I will be there and I am exposing the hundreds of billions of dollars in Medicaid fraud in child welfare.

HHS Secretary Sebelius, U.S. Attorney General Holder to Participate in Fifth Regional Health Care Fraud Prevention Summit in Detroit, Michigan

Federal, state, and local partners gather for summit to discuss fraud prevention efforts

WASHINGTON – On Tuesday, March 15^th U.S. Health and Human Services Secretary Kathleen Sebelius and U.S. Attorney General Eric Holder will deliver remarks at the fifth in a series of summits bringing together a wide-array of federal, state, and local partners, beneficiaries, providers, and other interested parties to discuss innovative ways to eliminate fraud within the U.S. health care system. The summit will include educational panels featuring law enforcement officials, consumer experts, providers, and key government agencies. Immediately following their remarks the Secretary and Attorney General will participate in a media availability.

On June 8, 2010, President Obama announced as part of a multi-faceted effort to crack down on Medicare fraud, a nationwide series of health care fraud prevention summits hosted by the Departments of Justice and Health and Human Services. Summits have already taken place in Miami, Los Angeles, Boston, and New York City.

WHO: Kathleen Sebelius, Secretary, U.S. Department of Health and Human Services

Eric Holder, U.S. Attorney General

WHEN: Tuesday, March 15, 2011

Summit: 9:00 a.m. – 12:30 p.m.

Sebelius/Holder Remarks: 11:45 a.m. EST

WHERE: Wayne State University

Community Arts Center

450 Reuther Mall
Detroit MI, 48202

NOTE:  All media must present government-issued photo I.D. (such as a driver’s license) as well as valid media credentials.

DOJ and HHS Host Second Health Care Fraud Summit

Of course, no Medicaid fraud in child welfare on the agenda.

Attorney General Holder and HHS Secretary Sebelius host second regional health care fraud prevention summit in Los Angeles

WASHINGTON - Today Attorney General Eric Holder and U. S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius kicked off the second in a series of daylong summits bringing together a wide array of federal, state and local partners, beneficiaries, providers and other interested parties to discuss innovative ways to eliminate fraud within the U.S. health care system.  The summit in Los Angeles included educational panels featuring law enforcement officials, including Assistant Attorney General Lanny A. Breuer of the Criminal Division, consumer experts, providers and key government agencies.

“In communities across the region, our health care system is under siege – exploited by criminals intent on lining their own pockets at the expense of American taxpayers, patients and private insurers,” said Attorney General Eric Holder.  “But through the Health Care Fraud Prevention and Enforcement Action Team, we are fighting back in bold, innovative and coordinated ways.  In addition, the Affordable Care Act provides new resources and includes tough penalties to help stop and prevent health care fraud.  We will continue to work vigorously with our law enforcement and private sector partners to punish those who steal from taxpayers, patients, seniors and other vulnerable Americans.”

Announced during the summit was a final regulation issued by the Centers for Medicare & Medicaid Services (CMS) increasing protections for both Medicare and Medicare beneficiaries from potentially fraudulent suppliers of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS). The new regulation enhances Medicare enrollment standards for DMEPOS suppliers by adding several new standards and strengthens existing standards that suppliers must meet before being able to furnish equipment and supplies to Medicare beneficiaries.

“The steps we are taking today provide us with additional tools to support our continuing efforts to reduce Medicare fraud by helping ensure that only appropriately qualified suppliers are enrolled in the program.  We know the majority of medical equipment suppliers and health care providers want to improve the health of Medicare beneficiaries, but we also know there are those who look for any opportunity to take advantage of beneficiaries and Medicare, including sham operations that are not legitimate businesses,” said Secretary Sebelius.

The summit also featured educational panels that discussed best practices for both providers and law enforcement in preventing health care fraud.  The panels included law enforcement officials, consumer experts, providers and representatives of key government agencies.

The recently enacted Affordable Care Act provides additional tools and resources to fight fraud in the health care system by providing an additional $350 million over the next 10 years through the Health Care Fraud and Abuse Control Account.

In addition, the Affordable Care Act toughens sentencing for criminal activity, enhances screenings and enrollment requirements, encourages increased sharing of data across government, expands overpayment recovery efforts, and provides greater oversight of private insurance abuses.  For information on the 2009 Health Care Fraud and Abuse Control Program Report, please visit www.justice.gov/dag/pubdoc/hcfacreport2009.pdf.

Investments in anti-fraud detection and enforcement pay for themselves many times over, and the Administration’s tough stance against fraud is already yielding results. In FY 2009, anti-fraud efforts put $2.51 billion back in the Medicare Trust Fund, a $569 million, or 29 percent, increase over FY 2008, and over $441 million in federal Medicaid money was returned to the treasury, a 28 percent increase from FY 2008.

The Affordable Care Act builds on innovative strategies to fight fraud, such as the Health Care Fraud Prevention and Enforcement Action Team (HEAT), the joint operation between the Department of Justice (DOJ) in partnership with the 94 U.S. Attorneys’ Offices, CMS and the HHS Office of Inspector General that has expanded Medicare Fraud Strike Force teams from South Florida and Los Angeles to now operating in seven regions to target health care fraud hot spots including Houston; Detroit; Brooklyn, N.Y.; Baton Rouge, La.; and Tampa, Fla.

On June 8, 2010, President Obama announced this nationwide series of regional fraud prevention summits as part of a multi-faceted effort to crack down on health care fraud. The Los Angeles summit was the second in a series, with additional summits to follow in the coming months in Detroit, Boston, New York, Philadelphia and Las Vegas.

On July 16, 2010, the U.S. Health and Human Services Secretary Kathleen Sebelius and U.S. Attorney General Eric Holder kicked-off the first in a series of Regional Health Care Fraud Prevention Summits in Miami.

Secretaries Sebelius and Duncan announce national coalition to enroll uninsured kids in health care

Secretaries Sebelius and Duncan announce national coalition to enroll uninsured kids in health care

The Urban Institute’s Genevieve Kenney presents new report on states’ success enrolling target populations in Medicaid and CHIP

WASHINGTON – U.S. Department of Health and Human Services Secretary Kathleen Sebelius and U.S. Department of Education Secretary Arne Duncan today highlighted the Connecting Kids to Coverage Challenge to enroll five million children in Medicaid and CHIP within five years. Since Sebelius announced the Challenge last February, the Centers for Medicare & Medicaid Services (CMS) have built an unprecedented coalition of partners, ranging from state governors to national advocacy organizations, who have stepped up to the challenge to enroll kids and educate families.

Although health coverage is currently available to children in families with incomes up to about $45,000 per year in nearly every state, an estimated five million uninsured children are eligible for Medicaid or CHIP but not enrolled.

“Nothing is more important to our future than the health of our children. No child should have to skip a doctor’s appointment or go without the medicine they need because their family can’t pay,” said Secretary Sebelius. “Despite the great advances that states have made over the years, there are nearly five million uninsured children who are currently eligible for coverage but are not enrolled. I’m challenging everyone, from my state and federal counterparts, to local governments and community-based organizations, to health centers and school districts, to faith-based groups and Indian tribes, to take this conversation about children’s coverage to the next level – to find and enroll those five million kids.”

”If a child is not healthy, he or she cannot learn,” said Secretary Duncan. “The education community has a critical role to play in finding and enrolling eligible children. We’re working to involve every member of the school community, including superintendents, principals, teachers, school nurses, and lunch room staff in meeting this achievable challenge.”

Secretaries Sebelius and Duncan were joined by Genevieve Kenney of the Urban Institute, whose new report Five Million Eligible But Uninsured: Who and Where Are the Children Yet to Enroll in Medicaid And The Children’s Health Insurance Program? was released in Health Affairs on-line today along with a Health Affairs Commentary by Secretary Sebelius, Rising to the Challenge: Tools for Enrolling Eligible Children in Health Coverage.

For years, researchers have struggled to produce accurate estimates on the number of uninsured children in each state. The paper released today by Health Affairs successfully created a new model, using data from The American Community Survey, that enabled researchers to produce meaningful national and state estimates. Some of the key findings include that:

• According to coverage estimates, an estimated 7.3 million children were uninsured on an average day in 2008, of whom 4.7 million (65 percent) were eligible for Medicaid or CHIP but not enrolled
• Participation rates varied across states from 55 percent to 95 percent
• Ten states had participation rates at or above 90 percent
• Thirty-nine percent of eligible uninsured children (1.8 million) live in just three states—California, Texas, and Florida—and 61 percent (2.9 million) are concentrated in ten states.

“This new data will help us to focus our efforts and our grant funding where they are most needed,” Sebelius said. “We now have a much better sense of where most uninsured children live, and which communities may need more help.”

Together, the Children’s Health Insurance Program Reauthorization Act (CHIPRA) and the Affordable Care Act provide $120 million for grants designed to promote enrollment and retention strategies that will increase the prevalence of health coverage.

One of this Administration’s key goals is to fulfill the CHIPRA legislation – which the President signed as one of his first acts in office – to ensure that all children who are eligible for Medicaid and CHIP are enrolled in coverage and stay enrolled for as long as they are eligible.

CHIPRA, combined with the American Recovery and Reinvestment Act of 2009 (ARRA) and its recent extension of increased federal Medicaid funding, has given states unprecedented federal support that has enabled them to keep providing essential health services for low-income families through Medicaid during the economic downturn.

To date, 17 national organizations and a number of states have agreed to sign on to the Connecting Kids to Coverage Challenge. These organizations, ranging from the United Way to the American Academy of Pediatrics, represent a broad base of organizations who are working to enroll children in health insurance. The full list includes:

• Governor Ted Strickland, Ohio
• Governor Ted Kulongoski, Oregon
• American Academy of Pediatrics
• Center on Budget and Policy Priorities
• Families USA
• First Focus
• March of Dimes
• MomsRising
• National Academy for State Health Policy
• National Association of Children’s Hospitals and Related Institutions
• National Association of Community Health Centers
• National Association of School Nurses
• National Council of La Raza
• National Covering Kids and Families Network
• New England Alliance for Children’s Health, Community Catalyst
• PICO
• The Robert Wood Johnson Foundation
• United Way Worldwide
• Voices for America’s Children

There are a wide range of strategies – like providing 12 months of continuous eligibility for Medicaid or CHIP to reduce the chances of children cycling on and off of coverage and pre-populating renewal forms to make it easier for families to stay enrolled – that are known to help get and keep children insured. HHS will be providing technical assistance as well as targeted grant funding to promote these strategies.
More information on the Secretary’s Challenge can be found at insurekidsnow.gov.

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This is an excellent initiative as it beats Child Protective Services to the punch.  By providing services and resources will reduce the number and rate of children entering the foster care system as being without the services provided by Medicaid and CHIP, the necessary needs of the child, will stop the excuse of poverty as being abuse and neglect. 

The best part of this initiative is that it will reduce Medicaid fraud in the foster care system as it will now be under a universal system more transparent than foster care.

Let's see what Michele Bachmann has to say about this.

New flexibility for states to improve Medicaid and implement innovative practices

New flexibility for states to improve Medicaid and implement innovative practices

New rules will make Medicaid more flexible and efficient, 
helping states provide better care and lower costs 

The U.S. Department of Health and Human Services (HHS) today announced four initiatives to give states more flexibility to adopt innovative new practices and provide better, more coordinated care for people with Medicaid and Medicare while helping reduce costs for states and families.  The initiatives support the Obama administration’s work to make Medicaid more flexible and efficient and to address long-term cost growth.  Several of the announcements also help implement provisions of the Affordable Care Act.  Today HHS announced:

Fifteen states will receive federal funding to develop better ways to coordinate care for people with Medicare and Medicaid coverage, also known as dual eligibles, who often have complex and costly health care needs. 

• All states will receive increased flexibility to provide home and community-based services for more people living with disabilities. 
• All states are eligible to receive more money to develop simpler and more efficient information technology (IT) systems to modernize Medicaid enrollment. 
• A proposal by the state of New Jersey for flexibility to expand health coverage for nearly 70,000 low-income residents has been approved. 

“Medicaid programs provide health coverage for millions of low-income Americans who otherwise would lack access to health care,” said HHS Secretary Kathleen Sebelius.  “With these new resources and flexibilities, states will have new options to make their Medicaid programs work better for the people they serve, while helping lower their costs.”

Coordinated Care for People with Medicare and Medicaid

Under a new initiative funded by the Affordable Care Act, 15 states will receive up to $1 million each to develop new ways to meet the often complex and costly medical needs of the approximately nine million Americans who are eligible for both the Medicare and Medicaid programs, known as “dual eligibles.”  The goal of the program is to eliminate duplication of services for these patients, expand access to needed care and improve the lives of dual eligibles, while lowering costs.  The new Federal Coordinated Health Care Office, or the Duals Office, at the Centers for Medicare & Medicaid Services (CMS), was created by the Affordable Care Act to improve care for dual eligibles and will work with the states to implement the top strategies to coordinate primary, acute, behavioral and long-term supports and services for dual eligibles, improving quality and lowering costs. 

The 15 states that will receive these funds are California, Colorado, Connecticut, Massachusetts, Michigan, Minnesota, New York, North Carolina, Oklahoma, Oregon, South Carolina, Tennessee, Vermont, Washington and Wisconsin.

“Beneficiaries who are in both Medicare and Medicaid can face different benefit plans, different rules for how to get those benefits and potential conflicts in care plans among providers who do not coordinate with each other,” said Donald M. Berwick, M.D., administrator of CMS.  “This can be disastrous for those beneficiaries who are most vulnerable and in need of help.”

Helping People with Disabilities Live in their Communities

CMS proposed new rules today giving states new flexibility for their programs to help people with disabilities choose to live in their communities rather than in institutions.  The proposed rules reduce administrative barriers for states seeking to help multiple populations, which may include seniors and/or people with different types of disabilities.  They will also allow individuals to participate in the design of their own array of services and supports, including such things as personal care and respite services for caregivers.

“These long awaited rules will help people living with disabilities realize the promise of the ADA to live in the least restrictive environments possible for them—like their own homes,” said Henry Claypool, director of the Office on Disability at HHS.  “With these new tools as well as incentives included in the Affordable Care Act, states, working closely with advocacy groups, beneficiaries, and other stakeholders, can more easily develop effective plans to improve options for people with disabilities.  We hope states will take advantage of this new flexibility.”

The proposed rule, CMS-2296-P, can be found at www.ofr.gov/inspection.aspx.

Developing and Upgrading Medicaid IT Enrollment Systems

New rules issued today will provide 90-percent of the cost for states to develop and upgrade their IT systems to help people enroll in Medicaid or the Children’s Health Insurance Program (CHIP) – and
75-percent of ongoing operational costs.  This increase over the previous federal matching rate of
50-percent will help states prepare for the Medicaid improvements and expansion that will come in 2014 from the Affordable Care Act, when many more Americans will be eligible for these programs, and to coordinate enrollment with the Exchanges.  The rules establish performance standards for the improved eligibility systems to promote greater efficiency and a more consumer-friendly enrollment process.

The final regulation, CMS-2346-F, can be found at www.ofr.gov/inspection.aspx.

Expanding Health Coverage in New Jersey

HHS Secretary Kathleen Sebelius today approved a Section 1115 demonstration for New Jersey that will expand health coverage to nearly 70,000 uninsured, low-income people through the Work First New Jersey program.  In addition, the state will increase care coordination to improve health outcomes for participants in the program.

 “This demonstration is yet another example of the many flexibilities states have to adapt their Medicaid programs to better serve their residents,” said Secretary Sebelius.  “I want to commend New Jersey for expanding coverage to people in need.”

For more information about these announcements, visit www.cms.gov/apps/media/fact_sheets.asp.

OBAMA ADMINISTRATION ANNOUNCES $500 MILLION FOR RACE TO THE TOP-EARLY LEARNING CHALLENGE

OBAMA ADMINISTRATION ANNOUNCES $500 MILLION FOR RACE TO THE TOP-EARLY LEARNING CHALLENGE

New State Competition to Establish and Expand High Quality Early Learning Programs

U.S. Secretary of Education Arne Duncan and U.S. Health and Human Services Secretary Kathleen Sebelius today announced a new $500 million state-level grant competition, the Race to the Top-Early Learning Challenge. Joining Duncan and Sebelius at the announcement were business, law enforcement and military leaders who have advocated for increased investments in early learning to reduce crime, strengthen national security, and boost U.S. competitiveness.

“For kids, high quality early learning programs mean they will enter school better prepared with a greater chance of finishing high school and college,” said Vice President Joe Biden, Chairman of the Administration’s Middle Class Task Force. “Expanding access to such early education and child care programs will also make it easier for working parents to hold down a job – a key priority of the Middle Class Task Force – giving them peace of mind that their children are in a high quality learning environment while they are at work.”

“To win the future, our children need a strong start,” said Secretary Duncan. “The Race to the Top-Early Learning Challenge encourages states to develop bold and comprehensive plans for raising the quality of early learning programs across America.”

"This Challenge represents the Obama Administration’s commitment to helping vulnerable children and families reach their full potential,” said Secretary Sebelius. “Our collective health and financial security as a nation will depend on high quality investments during the critical early years of a child’s life.”

The Race to the Top-Early Learning Challenge will reward states that create comprehensive plans to transform early learning systems with better coordination, clearer learning standards, and meaningful workforce development. Secretary Duncan and Secretary Sebelius also challenged the broader innovation community – leading researchers, high-tech entrepreneurs, foundations, non-profits and others – to engage with the early learning community and to close the school readiness gap.

States applying for challenge grants will be encouraged to increase access to quality early learning programs for low income and disadvantaged children, design integrated and transparent systems that align their early care and education programs, bolster training and support for the early learning workforce, create robust evaluation systems to document and share effective practices and successful programs, and help parents make informed decisions about care for their children.

Research shows that high-quality early learning programs lead to long-lasting positive outcomes for children, including increased rates of high school graduation, college attendance and college completion. Yet, just 40 percent of 4-year olds in America are currently enrolled in preschool programs. The most recent report from the National Institute for Early Education Research (NIEER) indicates that, for the first time in a decade, states are reducing some of their key investments in early learning.

The Race to the Top-Early Learning Challenge grants will encourage states to make the best possible use of current federal and state investments in child care and early learning. The Obama Administration has sought and secured increased investments in Head Start and child care so that more families have access to quality, affordable care, while also pursuing important reforms such as requiring Head Start grantees to compete for continued funding. The administration has also steered resources towards evidence-based, cost-effective home visiting programs.

In his remarks today, Duncan also thanked Congress for supporting Race to the Top saying, "We are deeply grateful to Congress for supporting these programs. Congress understands the value of investing in education reform, particularly early learning, even in these economic times."

The Race to the To-Early Learning Challenge will be administered jointly by the Department of Education and the Department of Health and Human Services. Starting today, the public may provide input, including data and relevant research, by visitinghttp://www.ed.gov/blog/2011/05/watch-live-duncan-and-sebelius-make-major-announcement-about-race-to-the-top-and-early-learning/. Guidance, eligibility, range of awards and number of grants will be announced in coming weeks. The application will be released later this summer with grants awarded to states no later than December 31, 2011.

Nothing Quick & Dirty in Florida Healthcare Fraud Summit

For viewing pleasure, I shall go through this press release and identify the limitations of using data mining for the purposes of detection and preventing Medicaid fraud in child welfare in red.

HHS Announces New Tool to Help Fight Health Care Fraud in Florida

HHS Secretary Sebelius and Attorney General Holder to Co-Host Fraud Prevention Summit Tomorrow in Miami

U.S. Health and Human Services Secretary Kathleen Sebelius announced today that health care fraud fighters in the state of Florida will now have additional funding to help find potential fraud and abuse in the state’s Medicaid program through the use of Medicaid claims data.

The health care fraud fighters in Florida who are versed in the area of Medicaid fraud in child welfare, including those who are willing to import this expertise to the state, are typically grassroots organizations and lone parents whose parental rights have been terminated who have been made out to be dismissed on their cries of fraud in child welfare.  Lacking the sophistication to participate in qualification of this additional funding, Medicaid fraud in child welfare will continue along its happy incremental increase slope.

Today, Secretary Sebelius approved Florida’s Medicaid waiver request to help fund a demonstration program that will allow the state’s Medicaid Fraud Control Unit (MFCU) to “mine” Medicaid Management Information System (MMIS) data to identify cases of potential Medicaid fraud.

The MFCU will rely upon subcontracting this data mining demonstration program to Maximus, Inc.   With a reputation of being the "jeepers-creepers keeper" of the record, Maximus, Inc. does not have a very reliable track record when it come to skills, knowledge and abilities (I refer to as the "skas") when it comes to handling data.

Corporate Integrity Agreement between the HHS OIG and Maximus, Inc. 2007  

Medicaid billing for many health care services in South Florida is disproportionately high compared to other parts of the country. Although significant progress has been made, fraudulent billing health care fraud continues to cost Medicaid millions of dollars.

Medicaid billing in child welfare for the state is proportional to the other States as the pattern exists in every state.  Very little progress has been made in Florida regarding the aberrant billing practices in child welfare fraud which continues to cost Medicaid billions of dollars. 

“To fight health care fraud, we need to coordinate all of the resources and data we can muster,” said Secretary Sebelius. “By allowing the state of Florida to use more information to find potential fraud in Medicaid, this waiver will improve Florida’s ability to effectively identify and combat fraud and abuse.”

There is a reason why there will never be a coordination of resources and data to end Medicaid fraud in child welfare because the child abuse propaganda marches to the tune of the imperialistic morality parade.

The announcement comes in advance of the Department of Health and Human Services and Department of Justice’s first Regional Health Care Fraud Prevention Summit being held tomorrow at the Knight Center in Miami, Fla.

The summit, which will feature keynotes remarks by U.S. Attorney General Eric Holder and Secretary Sebelius, kicks off the first in a series of day-long summits bringing together a wide array of federal, state, and local partners, beneficiaries, providers, and other interested parties to discuss innovative ways to eliminate fraud within the U.S. health care system.

As part of its efforts to coordinate the fight against fraud across the nation’s health care systems, including Medicaid and Medicare, data mining will allow Florida’s MFCU to sort electronic claims through the use of statistical models and intelligent technologies to uncover patterns and relationships. Using the identified patterns, investigators can review Medicaid claims activity and history to find abusive or abnormal use of services and billing that may be potentially fraudulent. Data mining is done with software programs which include algorithms that automatically analyze the MMIS data.

The HHS Inspector General reported to Congress just a few months ago that the MMIS data were not "timely, accurate, or comprehensive for detection of fraud, waste, and abuse."  The MMIS data, handled by the unenlightened over at Maximus, Inc. is not the only database Florida has to execute the task of ending Medicaid fraud in child welfare.

There are other statistical methodologies that can easily be applied to detect patterns and relationships of fraud in child welfare.  There are other databases and potential other databases that can be analyzed but will never see the light of day.   

There is no oversight and no reporting avenues for fraud in child welfare.   There is no exclusionary database in child welfare.

Currently, state MFCUs are prohibited from using federal Medicaid matching funds to detect potential fraud through routine claims review procedures such as screening of claims, analysis of billing practice patterns, or routinely verifying that billed services were actually received by patients, since these functions are a primary program operation function of the state Medicaid agency. Instead, MFCUs generally rely on referrals from the State Medicaid agency. The waiver approved today will allow the Florida MFCU to use federal matching funds to apply sophisticated electronic data mining tools that are beyond the scope of the claims review activities normally performed by the State Medicaid agency to identify potential fraud.

Currently, the MFCU is prohibited from ending Medicaid fraud in child welfare.  The MFCU is located in the Office of the Attorney General.  The Attorney General represents state agencies in dealing with child welfare.  There exists an inherent conflict of interests for the MFCU to prosecute and recover Medicaid fraud in child welfare as it is the entity which defends the actions of the state agencies that have committed Medicaid fraud in child welfare.

In addition, there was nothing written in the final rules mandating MFCUs to address Medicaid fraud in child welfare.  The final rules exclusively were designed to address the aged and "safe harbors", exceptions to fraud practices.

The Centers for Medicare & Medicaid Services (CMS) expects the MFCU to work closely with AHCA to ensure their collective efforts are effective. CMS will monitor the progress of this waiver in conjunction with the HHS Office of Inspector General, which has oversight of MFCUs.

CMS should expect to work closely with the people to ensure there collective efforts to end Medicaid fraud in child welfare will take effect, otherwise, Medicaid fraud (as well as all other frauds) in child welfare will only be addressed under the False Claims Act.  Unfortunately, there are very few law firms that are willing to grasp the concept that fraud in child welfare even exists.

“The demonstration approved today will allow Florida’s Medicaid Fraud Control Unit to take full advantage of their expertise in detecting and investigating Medicaid fraud,” said CMS Administrator Don Berwick, M.D. 

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George Sheldon joins Obama administration

Congrats, George!  We shall do lunch, very soon.  We have lots of fraud to talk about ending.

George Sheldon joins Obama administration

That job we said George Sheldon was getting with the Obama administration ... it's official now.
This afternoon Health and Human Services Secretary Kathleen Sebelius announced that Sheldon would join the Administration for Children and Families. (Her note to staff is in the jump.)
Sheldon, who was head of Florida's Department of Children and Families under Gov. Charlie Crist, will get a sendoff from friends at Clyde's in Tallahassee beginning at 7 p.m. tomorrow.
To: ACF Staff and HHS Senior Leadership
From: Secretary Kathleen Sebelius
I am very pleased to announce that George Sheldon will be joining HHS in the Administration for Children and Families (ACF).  He will serve as Senior Advisor to David Hansell until David’s departure on June 17th when he will become the Principal Deputy Assistant Secretary and Acting Assistant Secretary at ACF.  

George comes to us with over 35 years of national, state, and local government experience, having served most recently as Secretary of the Florida Department of Children and Families (DCF).  Prior to that, he served as that Department’s Assistant Secretary for Operations.  During his time in Florida, George oversaw the state’s child welfare programs, fostering a 36% reduction in children in out-of-home care, focusing closely on integrating mental health and domestic violence services throughout the Department. He also helped the state dramatically reduce their SNAP error rate to become a national leader.

In early 2010, George worked closely with federal partners at HHS and ACF in the aftermath of Haiti’s catastrophic earthquake.  Together, Florida and ACF met the needs of over 27,000 American citizens, 700 medical evacuees, and 600 Haitian children moving through the adoption process with American families.  Before his service at DCF, George was Associate Dean for Student and Alumni Services at St. Thomas University School of Law.  In 1975, George was elected to the Florida House of Representatives, where he built an eight-year record focusing on the environment and children. 

Born in Wildwood, New Jersey, George received both his B.A. and J.D. from Florida State University. 

Please join me in welcoming George to the Department.  We look forward to his leadership.

LePage crashes DHHS deliberations: 'Get this done'

AUGUSTA — As lawmakers on the Legislature's budgetary committee grilled the chief of the Department of Health and Human Services on Friday on whether the state would receive federal waivers to make some of Gov. Paul LePage's proposed Medicaid reductions legal, a member of the audience was eager to talk. 

LePage. 

The governor raised his hand at least three times and requested to speak. After the final time, Appropriations Committee co-chairman, Sen. Richard Rosen, R-Bucksport, invited LePage to the interview table. 

During his forceful remarks, the governor reiterated the reasons lawmakers have to ratify his $221 million proposal to reduce Medicaid services.

LePage had given some of the reasons before, but not in this forum, not this way. 

What brought LePage to Appropriations was a letter from the federal Centers for Medicare & Medicaid Services which appeared to present a tall hurdle for $37 million of the governor's proposed cuts. The letter from CMS Director Cindy Mann indicated that the state might not obtain a waiver from the federal health care law to reduce Medicaid eligibility solely for budgetary purposes.

The letter concerned lawmakers on Appropriations, who are being asked to green-light some of LePage's Medicaid reductions, although proposals might not receive federal approval. 

The letter is also a concern for LePage, who is attempting to fill a $221 million budget gap at DHHS.

On Friday, the governor briefly discussed the CMS letter, saying he would personally make the case for the federal waiver to U.S. Health and Human Services Secretary Kathleen Sebelius. 

"If this (budget) is not approved by Feb. 1 and I don’t get on a plane on Feb. 2 and stay in Sebelius’ office, on April 1, the state of Maine will default," LePage said during more than seven minutes of remarks. "(Maine) will not have the money to pay the fourth-quarter 2012 Medicaid payments."

The governor said the cuts were required to keep state money flowing to schools and to keep nursing homes open. 

". . . I will be calling you back and asking you to give me the (General Purpose Aid to Education) money so that I don’t have to close nursing homes and we will probably have to close schools," said LePage, adding that he'd have to call the Legislature back into session before requesting education funding.

He added, "This is not normal politics. This is not rhetoric."

LePage said lawmakers were mistakenly addressing his budget proposal as a budget cut.

"It is not," the governor said. "It is (that) we are running out of money and this is the only way that I see to preserve the nursing homes."

He added, "Believe me, give me $221 million today, I go home, call it a day, business as usual." 

LePage said the Medicaid issue was brought to lawmakers last year in his biennial budget. However, he said, the Legislature did not approve his proposed reductions. 

"Well, the fact of the matter is we are spending at a much faster clip than we even thought," he said. "It’s taken us several months to recognize that we are blowing, or spending, an excess of $10 to $12 million a month more than we have. Add that up by 12 months, you’re at $125 million."

The governor stressed that Maine had been too generous with its Medicaid. He said the state pays "upwards of 200 percent over the federal poverty level for Medicaid" when other states "pay as low as 17 percent."

According to DHHS figures, the 200 percent statement turns out to be a generalization that represents two of the state's Medicaid offerings. Nonetheless, the state does exceed the federal poverty level in other programs.

"What we’ve done as a state has been very, very generous over the last decade," LePage said. "And that’s good. There were good times and we could afford it . . . We are not there any longer. We are not in the good times." 

The governor acknowledged that people would lose their health care if his proposal is ratified. However, he said, some would seek private insurance and others would take insurance through their employers. The latter individuals, he said, were discouraged from doing so because MaineCare provided a richer benefit that's funded by taxpayers.

"There isn’t enough money in Maine to feed the beast," LePage said.

The governor urged lawmakers to "get this done."

"I need to get (to) Washington and and try and sit with (Sebelius) and convince her that the game of being overly generous and the economy is such that they need to work with us," he said. 

LePage asked if lawmakers had questions. None did. Several appeared surprised that the governor had chosen to address the panel.

"I’ll answer any questions if you have any," LePage said, "otherwise I’m going downstairs to make a phone call to Secretary Sebelius."

It remains to be seen whether lawmakers will be heartened by the governor's promise to try to persuade Sebelius to grant the Medicaid waivers. Prior to his remarks, Maine DHHS Commissioner Mary Mayhew cautioned lawmakers about drawing conclusions from the letter.

"This response from CMS is not helpful, nor is it based on a formal proposal," said Mayhew, adding that state officials had been working with the Attorney General's Office to gauge whether the state had a chance to obtain the waivers from the Affordable Care Act.

Mayhew said the health care law's Maintenance of Effort provision was tying the state's hands in addressing its Medicaid budget. She said the federal government should be persuaded to grant an MOE waiver, given a shortfall that threatened its entire Medicaid program. 

Mayhew also noted that the state would seek assistance from its congressional delegation to obtain the waivers. 

U.S. Rep. Chellie Pingree, D-Maine, recently said the waivers appeared unlikely. 

U.S. Sen. Susan Collins, R-Maine, in a written statement Friday, stopped short of endorsing the MOE waiver, saying it was "imperative for the federal Department of Health and Human Services to work closely with the state to maintain the safety net that protects our most vulnerable citizens."

U.S. Sen. Olympia Snowe, R-Maine, went further.

She highlighted an amendment she helped secure in the federal health care law that would mirror what the governor is trying to do with childless adults on MaineCare. 

Snowe said the amendment was trying to fix an inequality in which states with low eligibility didn't have to make the same tough budget decisions as states like Maine with higher eligibility. 

She said that if the federal waiver is granted to lower the eligibility for childless adults from 200 percent above poverty level to 133 percent, Maine "would still have income thresholds for parent coverage that would be higher than 40 other states."

She added, "Indeed, 17 states have coverage only up to 50 percent of poverty, with five states covering only up to 30 percent."

Snowe said the government must continue to help those most greatly affected by the economy.

"At the same time," she said, "there are tremendous fiscal challenges confronting the state, including those resulting from the rising costs of MaineCare."

Single Payer Health Care Pilot Program A Success

This is the look of the future of health insurance.  This is it.  This is a single payer program.

Congressman John Conyers, Jr. has been promoting a Single Payer Program for health care for everyone to be eligible with his United States National Health Care Act, HR 676.  This program deals with a single payer source, not specifically a "single individual" paying into the program with tax dollars.

The single payer is a financial term referring to a single funding source.  When there is a single funding source, in the instance of the CHIRPA Medicaid programs for children and families, the ability exists to provide transparency, accountability and oversight through its counter program, and that is the single audit.

In the United States, the Single Audit, also known as the OMB A-133 audit, is a rigorous, organization-wide auditor examination of an entity that expends $500,000 or more of Federal assistance (commonly known as Federal funds, Federal grants, or Federal awards) received for its operations.^[1][2][3] Usually performed annually,^[4] the Single Audit’s objective is to provide assurance to the US federal government as to the management and use of such funds by recipients such as states, cities, universities, and non-profit organizations. The audit is typically performed by an independent certified public accountant (CPA) and encompasses both financial and compliance components. The Single Audits must be submitted to the Federal Audit Clearinghouse along with a data collection form, Form SF-SAC.


OMB Circular A-133 Compliance Supplement 2009
The Single Audit ensures there is efficiency in the delivery of services, there is continuous quality improvement of programs and services, and enforces mandatory compliance with the terms of funding source, reducing fraud, waste and abuse.

With the Electronic Health Records  incentive programs, it is only with a click of the button that these single payer programs can be reviewed through auditing programs.

Even more so, there are other codified mechanisms to ensure accountability of single payer programs such as the Sarbanes-Oxley Act.

When there are such oversight mechanisms in place, there is always an improvement in program goals.  The goals of any program is to provide care for the health of society.  Through the investment in the best interests of the child, the national society profits when the program produces a future taxpaying citizen.  The child becomes a health adult.  A healthy adult becomes part of a healthy nation.  A healthy nation lessens the drain on its economical resources.

The Medicare model of the single payer will eventually be adopted.  When it does, there will already be a plan for implementation as its pilot program is dealing with children and families.

Two Year Anniversary of Children’s Health Insurance Law Sees Millions of Newly Insured Children, Families

Two years after President Obama signed the Children’s Health Insurance Program Reauthorization Act, HHS Secretary Kathleen Sebelius today announced that more than two million more children were served by Medicaid or the Children’s Health Insurance Program (CHIP) at some point over the past year.

Together, the two programs serve more than 42 million children who would otherwise not have access to regular medical care.

“The increase in the number of children served by these two vital programs is especially significant in the face of the recent economic downturn states are experiencing,” said Secretary Sebelius. “Even in times of hardship, states have demonstrated their commitment to the health of children by continuing efforts to identify and enroll them in coverage.”

To continue to advance coverage for children, Secretary Sebelius today also announced $40 million in new grants to states, community-based organizations, school systems and others to support their outreach and enrollment activities.  The grants will help states further modernize and streamline their administrative systems, as well as create and implement school-based outreach strategies and approaches for identifying children who have historically been hard to reach.

Today’s grant announcement builds on $206 million in enrollment bonuses earned by 15 states last year that increased enrollment above specific target levels.  The bonus funds help states cover the cost of enrolling additional children in Medicaid.

“As we mark the second anniversary of one of President Obama’s first actions as President, we can be confident that CHIPRA has proven to be a tremendous success,” said Sebelius. “Now we must build on our accomplishments. Today, I am again calling on leaders across the country – from federal, state and local officials to private sector leaders – to join our effort to insure more children. We all have a stake in America’s children and together, we will ensure millions more children get the care they need.”

States were able to increase enrollment in the two programs in part because of boosts in federal support provided by the American Recovery and Reinvestment Act (ARRA).  ARRA temporarily increased federal matching funds for state Medicaid programs during the recession.

While Medicaid and CHIP have helped bring the rate of uninsured children to the lowest level in more than two decades, an estimated five million uninsured children are thought to be eligible for one of these programs, yet not covered.

The Secretary’s Challenge: Connecting Kids to Coverage, launched last year, will continue support efforts to reach more children by providing leaders with critical information and support as they work to insure more children in their communities and by closely monitoring progress. 

“States’ continued progress toward enrolling all eligible children in coverage is a significant step in cushioning the recession’s impact on access to health insurance,” said Cindy Mann, director, Center for Medicaid, State and Survey and Certification Operations, within the Centers for Medicare & Medicaid Services (CMS). “As families lose employment or have their hours cut back they may lose the health coverage benefit that came with that job.  If not for these two programs, millions more children would go without critical health care services.”

In its second annual report on CHIP and Medicaid enrollment, CMS notes that:

• More than 2 million children gained Medicaid or CHIP coverage during federal fiscal year 2010 (October 1, 2009 – September 30, 2010). In total, Medicaid and CHIP served more than 42 million children last year. This steady increase in enrollment is evidence of the important role that Medicaid and CHIP play for children, especially during economic downturns.  The uninsured rate for children continues to decline at a time with the rate for adults is climbing.  The increase in children’s enrollment demonstrates that Medicaid and CHIP are serving the purpose for which they were created – providing high quality health coverage for lower-income families.
• Thirteen states implemented eligibility expansions in 2010 and many others simplified their enrollment and renewal procedures.  Forty-six states and the District of Columbia now cover children with incomes up to 200 percent of the federal poverty level (FPL) in Medicaid and CHIP; with 24 of those states and the District of Columbia covering children with incomes up to 250 percent of the FPL.  Twenty-one states now offer coverage to lawfully residing immigrant children and/or pregnant women, enabling states to receive federal funding for this coverage.
•  CHIPRA Performance Bonuses have encouraged states to adopt and augment simplification measures in Medicaid and CHIP. Fifteen states qualified for a total of $206 million in performance bonuses for FY 2010; this is a significant increase over 2009 where 10 states received bonuses totaling $75 million. These bonuses provide additional federal financial support each year to states that successfully boost enrollment above target levels among previously eligible but uninsured children in Medicaid.  To qualify, a state not only has to enroll more children, but must also have implemented program features that are designed to promote enrollment of eligible children. 
• States are increasing their use of technology to facilitate children’s enrollment and retention.  Nearly two-thirds of states (32) have an on-line application that can be submitted electronically; 29 states allow electronic signatures on those applications.  Six states have received approval to enroll children through the “Express Lane Eligibility” option created by CHIPRA.  Express lane eligibility allows states to use data gathered for other programs such as housing assistance or food stamps to determine Medicaid or CHIP eligibility. And 33 states are utilizing the CHIPRA data matching process provided by the Social Security Administration to confirm U.S. citizenship for children.
• Outreach and enrollment grants have advanced coverage and led to public-private partnerships throughout the country to enroll more children. Sixty-eight grantees across 41 States and the District of Columbia are working diligently to facilitate children’s enrollment in health coverage 

Children's Health Insurance Program Reauthorization Act (CHIPRA) 2010 Annual Report